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UK Guardian – 26 February 2008.

A bitter pill

Millions of prescriptions for SSRIs are written up in the UK each year, but a major study says they’re no better than placebo. What now for the citizens of Prozac Nation?

by Allegra Stratton

“Perhaps the next time half a million people gather for a protest march on the White House green,” wrote Elizabeth Wurtzel in her bestselling book Prozac Nation, “it will not be for abortion rights or gay liberation, but because we’re all so bummed out.”

Or it might be to protest that the antidepressants so many of them had been prescribed might, after all, be dud.

Today, a major new study shows that Prozac, taken by 40 million people worldwide, does not work and nor do similar types of drugs. For a profession normally diplomatic, the words today of one of study’s authors are damning. “Given these results”, Professor Kirsch of Hull University says, “there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients.”

But prescribed they have been. If Wurtzel called America the United States of Depression, statistics published last year cast the UK as the “Unhappy Kingdom”. According to mental health charity MIND, using information supplied by the NHS, 31 million batches of Prozac were prescribed in 2006 in England alone, up 6% on the year before.

Spread evenly over the UK’s 37 million people of working age, that’s nearly one prescription per adult.

And what does it cost? Antidepressant prescriptions cost the health service £3.3bn last year. One thirty-fifth of the entire NHS budget.

The class of drug called selective serotonin reuptake inhibitors (SSRIs), which includes Prozac, became available in the late 1980s. By 1994 the taking of such drugs was widespread and Wurtzel’s book marked the point at which they completed the journey from the shrink’s couch to the living room sofa where they have stayed. Since the early 90s the Mental Health Foundation says the number of prescriptions written for antidepressants has tripled.

GPs seem to recognise the problem. Responding to a recent survey by the Mental Health Foundation, 57% of GPs said that antidepressants were over-prescribed and that even though they had been recommended not to by the National Institute for Clinical Excellence, 55% of them used the drugs as their first response to mild or moderate depression.

More than three-quarters of GPs said they had prescribed an antidepressant in the last three years, despite believing that an alternative treatment might have been more appropriate, most commonly because there was a long waiting list for the alternative.

Oliver James, who has worked as a clinical psychologist both on and off television screens for over 30 years, doesn’t think such ready Prozac prescription will fall in the future.

He argues that diminished government funding for mental health services may explain the rise in prescriptions. “There is nothing else [GPs] can do. There just isn’t any alternative in too many parts of the country. The government try to use cognitive behaviour therapy. This just isn’t enough.”

It’s hard to tell how a Wurtzel of 14 years ago or even a Britney Spears of today would respond to being told to go for a bracing walk, but GPs are now being encouraged to prescribe “ecotherapy” instead of drugs. On this there seems to be progress.

The Mental Health Foundation claims that 22% of GPs now prescribe exercise therapy as one of their most common treatments for depression compared with only 5% three years ago.

Marjorie Wallace, chief executive of the mental health charity SANE, wants to see more evidence before discarding SSRIs, drugs that she says were once the “great hope for the future” allowing people release from the “crippling effect of the old tricyclic antidepressants which could be fatal”. If the research is validated in future Wallace fears psychological therapies will become the new prescription of choice, even though they do not work for everyone.

“These findings could remove what has been seen as a vital choice for thousands in treating what can be a life threatening condition.”

For now, Wallace pleads for sufferers to carrying on taking their medication.

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